96-21980 RESO
RESOLUTION NUMBER 96-21980
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF
THE CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING AND
DIRECTING THE MAYOR AND CITY CLERK TO EXECUTE
"AMENDMENT NO.2" TO CONTRACT NUMBER KL 104 WITH
THE DEPARTMENT OF HEALTH AND REHABILITATIVE
SERVICES (HRS) IN ORDER TO COMPLY WITH HRS' NEW
BILLING PROCESS.
WHEREAS, on June 7, 1995, the City signed and executed Contract Number
KL 104 with the State of Florida Department of Health and Rehabilitative Services (HRS),
for funding of the Adult Developmental Training Program at the City's Log Cabin Training
Center (Contract); and
WHEREAS, said Contract is in full force and effect; and
WHEREAS, in order to comply with the HRS requirements, the City must amend the
Contract to include the revised attachment, entitled "Amendment No.2", reflecting that
funds in the Contract will be transferred from HRS general revenue contractual slots to
HRS Medicaid Waiver slots; and
WHEREAS, HRS has assured the City that this action will in no way effect the City's
ability to collect the total funds contemplated in the Contract; and
WHEREAS, no other changes to the Contract are being made at this time.
NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City
Commission hereby authorize the Mayor and City Clerk to execute the attached
Amendment No. 2 to Contract Number KL 104 with the Department of Health and
Rehabilitation Services (HRS).
PASSED AND ADOPTED THIS
,1996.
ATTEST:
~o~~ ~cucluA-
CITY CLERK
. M APPROVEU
LEGAL DEPT.
By /t; ~
[late )'- y..... )L.._. .
CITY HALL 1700 CONVENTION CENTER DRIVE MIAMI BEACH FLORIDA 33139
CITY OF MIAMI BEACH
COMMISSION MEMORANDUM NO. ;:} 1 L -~ t,.,
TO:
Mayor Seymour Gelber and
Members of the City Commission
DATE:
May 15,1996
FROM:
Jose Garcia-Pedrosa iL
City Manager
A RESOLUTION A . HORIZING AND DIRECTING THE MAYOR AND CITY
CLERK TO EXECUTE "AMENDMENT 2" TO CONTRACT NUMBER KL 104
WITH THE DEPARTMENT OF HEALTH AND REHABILITATIVE
SERVICES (HRS), IN ORDER TO COMPLY WITH HRS' NEW BILLING
PROCESS.
SUBJECT:
ADMINISTRATION RECOMMENDATION:
The Administration recommends adoption of the attached Resolution authorizing and
directing the Mayor and City Clerk to execute "Amendment 2" to Contract Number KL 104
with the Department of Health and Rehabilitative Services (HRS) in order to comply with
HRS' new billing process.
BACKGROUND
Since 1983, the City's Log Cabin Training Center, located at 8128 Collins Avenue, has
operated an HRS program entitled Adult Developmental Training (independent living skills
training) designed to benefit developmentally disabled adults. Clients participating in this
program are referred from either Health and Rehabilitative Services (HRS) or sponsored
by their own families. The program strives to teach its clients basic living skills, which will
allow them to become self-reliant and no longer entirely dependent upon welfare and social
service agencies for their sustenance.
ANALYSIS
On June 7, 1995, Contract number KL 104 with the State of Florida Department of Health
and Rehabilitative Services (HRS), was executed by the Mayor and City Clerk. HRS has
now requested an amendment to the contract, reflecting that the HRS general revenue
contractual slots be transferred to HRS Medicaid Waiver slots. HRS has assured the City
that this in no way impacts the total amounts of funds to be received by the City under the
AGENDA ITEM
c.~~
<c;-I 5- 9~
DATE
COMMISSION MEMORANDUM
MAY 15, 1996
PAGE 2
terms of the contract. Therefore, to ensure compliance with HRS requirements, the City
must amend the contract to include the revised attachment entitled "Amendment 2."
CONCLUSION
The Administration recommends adoption of the attached Resolution authorizing and
directing the Mayor and City Clerk to execute "Amendment 2" to Contract Number KL 104
with the Department of Health and Rehabilitative Services (HRS) in order to comply with
HRS' new billing process.
JGP/~:Ik
Attachment
AMENDMENT 2
TIllS AMENDMENT, entered into between the State of Florida, Department of Health and
Rehabilitative Services, hereinafter referred to as the "Department", and "City of Miami Beach"
hereinafter referred to as the "Provider", amends contract KL104.
1. Section II, Paragraph A, is hereby amended to read;
"To pay for services according to the conditions of Attachment I in an
amount not to exceed $105.286.40.subject to the availability offunds.
The State of Florida's performance and obligation to pay under this
contract is contingent upon an annual appropriation by the Legislature.
The cost of services paid under any other contract or from any other
source are not eligible for reimbursement under this contract."
2. This amendment shall begin on May 15, 1996, or the date on which the
amendment has been signed by both parties, whichever is later.
All provisions in contract and any attachments thereto in conflict with this
amendment shall be and are hereby changed to conform with this
amendment.
All provisions not in conflict with this amendment are still in effect and are
to be performed at the level specified in the contract.
This amendment and all its attachments are made a part of the contract.
IN WITNESS THEREOF, the parties have caused this 1 page Amendment to be executed by
their undersigned agents or officials as duly authorized.
STATE OF FLORIDA, DEPARTMENT
OF HEAL m AND REHABILITATIVE
SERVICE~
z
S
(print or Type Name)
Anita Bock
Mayor
(print or Type Title)
j;(a~ ;2/"') /9 r ~
Date
District Administrator
-0 .:< 8 . tClb
Date
FEDERAL ID NUMBER
VF596000372001
cbamenddoc
Con~ctNo. ~lO~
CFDA No. NLA
Grants and Aids N/ A
Client r8J Non-Client 0
Multi-District D
STATE OF FLORIDA
DEPARTMENT OF HEALTII AND REHABllJTATIVE SERVICES
STANDARD CONTRACT
THIS CONTRACT is entered into between the State of Florida, Department of Health and Rehabilitative
Services, hereinafter referred to as the "department", and The City of Miami Beach, hereinafter referred to as
the "provider".
THE PARTIES AGREE:
I. THE PROVIDER AGREES:
A.Requirements of Section 287.058, FS
To submit bills for fees or other compensation for
services or expenses in sufficient detail for a proper
pre-audit and post-audit thereof. Where applicable,
to submit bills for any travel expenses in accordance
with section 112.061, FS. The department may,
when specified in Attachment I, establish rates lower
than the maximum provided in section 112.061, FS.
To provide units of deliverables, including reports,
findings, and drafts as specified in Attachment I, to
be received and accepted by the contract manager
prior to payment. To comply with the criteria and
final date by which such criteria must be met for
completion of this contract as specified in Section III,
Paragraph A. of this contract. To allow public access
to all documents, papers, letters, or other materials
subject to the provisions of Chapter 119, FS, and
made or received by the provider in conjunction with
this contract. It is expressly understood that
substantial. evidence of the provider's refusal to
comply with this provision shall constitute a breach
of contract.
B.Federal Laws and Regulations
l.If this contract contains federal funds, the provider
shall comply with the provisions of 45 CFR, Part
74, and/or 45 CFR, Part 92, and other applicable
regulations as specified in Attachment I.
2.If this contract contains federal funds and is over
$100,000, the provider shall comply with all
applicable standards, orders, or regulations issued
under Section 306 of the Clean Air Act, as
amended (42 V.S.C. 1857(h) et seq.), Section 508
of the Clean Water Act, as amended (33 V.S.C.
1368 et seq.), Executive Order 11738, and
Environment~ Protection Agency regulations (40
CFR Part 15). The provider shall report any
violations of the above to the department.
3.If this contract contains federal funding in excess
of $100,000, the provider must, prior to contract
execution, complete the Certification Regarding
Lobbying form, Attachment N/ A. If a Disclosure
of Lobbying Activities form, Standard Form LLL,
is required, it may be obtained from the contract
manager. All disclosure forms as required by the
Certification Regarding Lobbying form must be
completed and returned to the contract manager.
C.Audits and Records
l.To maintain books, records, and documents
(including electronic storage media) in accordance
with generally accepted accounting procedures and
practices which sufficiently and properly reflect all
revenues and expenditures of funds provided by
the department under this contract.
2. To provide a financial and compliance audit to the
department as specified in Attachment II and to
ensure that all related party transactions are
disclosed to the auditor.
3. To include these aforementioned audit and record
keeping requirements in all approved subcontracts
and assignments.
4. To maintain and file with the department such
progress, fiscal and inventory reports as specifiedlin Attachment I, and other reports as the
department may require within the period of this
contract. Such reporting requirements must be
reasonable given the scope and purpose of this
contract.
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D.Retention of Records
To retain all client records, financial records,
supporting documents, statistical records, and any
other documents (including electronic storage media)
pertinent to this contract for a period of five (5)
years after termination of the contract, or if an audit
has been initiated and audit findings have not been
resolved at the end of five (5) years, the records
shall be retained until resolution of the audit
findings. The provider will cooperate with the
department to facilitate the duplication and transfer
of any said records or documents during the required
retention period.
E.Monitoring
Persons duly authorized by the department and
federal auditors, pursuant to 45 CFR, Part
92.36(i)(10), shall have full access to and the right to
examine any of said records and documents at all
reasonable times during said retention period or as
long as records are retained, whichever is later,
including any records, papers, documents, facilities
relevant to this contract, and/or interview any clients
and employees of the provider to be assured of
satisfactory performance of the terms and conditions
of this contract. Following such inspection the
department will deliver to the provider a list of its
comments with regard to the manner in which said
goods or services are being provided. The provider
will rectify all noted deficiencies provided by the
department within the specified period of time set
forth in the comments or provide the department
with a reasonable and acceptable justification for not
correcting the noted shortcomings. The provider's
failure to correct or justify within a reasonable time .
as specified by the department may result in the
withholding of payments, being deemed in breach or
default, or termination of this contract.
F .Indemnification
Provider agrees that it will indemnify, defend, and
hold harmless department and all of department's
officers, agents, and employees from any claim,
loss, damage, cost, charge, or expense arising out of
any acts, actions, neglect or omission by provider,
its agents, employees, or subcontracts during the
performance of the contract, whether direct or
indirect, and whether to any person or property to
which department of said parties may be subject,
except that neither provider nor any. of its
subcontractors will be li.able under this section for
d.amages arising out of injury or damage to persons
Contract No. (GL,.IO{.-
or property directly caused or resulting from the sole
negligence of the department or any of its officers
agents, or employees. '
Provider's obligation to indemnify, defend, and pay
for the defense or at the department's option, to
participate and associate with the department in the
defense and trial of any claim and any related
settlement negotiations, shall be triggered by the
department's notice of claim for indemnification to
provider. Provider's inability to evaluate liability or
its evaluation of liability shall not excuse provider's
duty to defend and indemnify within seven days after
such notice by the department is given by registered
mail. Only an adjudication or judgment after the
highest. appeal is exhausted specifically finding the
department solely negligent shall excuse performance
of this provision by providers. Provider shall pay
all costs and fees related to this obligation and its
enforcement by the department. Department's
failure to notify provider of a claim shall not release
provider of the above duty to defend.
G. Insurance
1. To provide adequate liability insurance coverage
on a comprehensive basis and to hold such liability
insurance at all times during the existence of this
contract. The provider accepts full responsibility
for identifying and determining the type(s) and
extent of liability insurance necessary to provide
reasonable financial protections for the provider
and the clients to be served under this contract.
Upon the execution of this contract, the provider
shall furnish the department written verification
supporting both the determination and existence of
such insurance coverage. Such coverage may be
provided by a self-insurance program established
and operating under the laws of the State of
Florida. The department reserves the right to
require additional insurance as specified In
Attachment I where appropriate.
2. If the provider is a state agency or subdivision as
defined by s. 768.28, FS, the provider shall
furnish the department, upon request, written
verification of liability protection in accordance
with s. 768.28, FS. Nothing herein shall be
construed to extend any party's liability beyond
that provided in s. 768.28, FS.
H.Safeguarding Information
Not to use or disclose any information concerning a
recipient of services under this contract for any
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purpose not in conformity with the state regulations
and federal regulations (45 CFR, Part 205.50),
except upon written consent of the recipient, or his
responsible parent or guardian when authorized by
law.
I.Assignments and Subcontracts
1.To neither assign the responsibility of this contract
to another party nor subcontract for any of the
work contemplated under this contract without
prior written approval of the department.
2. Unless otherwise stated in the contract between the
provider and subcontractor, payments made by the
provider to the subcontractor must be within seven
(7) working days after receipt of full or partial
payments from the department in accordance with
s. 287.0585, FS. Failure to pay within seven (7)
working days will result in a penalty charged
against the provider and paid to the subcontractor
in the amount of one-half of one (1) percent of the
amount due, per day from the expiration of the
period allowed herein for payment. Such penalty
shall be in addition to actual payments owed and
shall not exceed fifteen (15) percent of the
outstanding balance due.
J .Return of Funds
To return to the department any overpayments due to
unearned funds or funds disallowed pursuant to the
terms of this contract that were disbursed to the
provider by the department. The provider shall
return any overpayment to the department within 40
calendar days after either discovery by the provider,
or notification by the department, of the
overpayment. In the event that the provider or its
independent auditor discovers an overpayment has
been made, the provider shall repay said
overpayment within 40 calendar days without prior
notification from the department. In the event that
the department first discovers an overpayment has
been made, the department will notify the provider
by letter of such a finding. Should repayment not be
made in a timely manner, the department will charge
interest of one (1) percent per month compounded on
the outstanding balance after 40 calendar days after
the date of notification or discovery.
K.lncident Reporting
1. Client Risk Prevention
If services to clients will be provided under this
contract, the provider and any subcontractors
Contract No. kLlO{.-
shall, in accordance with the client risk prevention
system, report those reportable situations listed in
HRSR 215-6 Paragraph 5, in the manner
prescribed in HRSR 215-6 or district operating
procedures.
2. Abuse, Neglect and Exploitation Reporting
In compliance with Chapter 415, FS, an employee
of the .provider who knows, or.. has reasonable
cause to suspect, that a child, aged person or
disabled adult is or has been abused, neglected, or
exploited, shall immediately report such
knowledge or suspicion to the central abuse
registry and tracking system of the department on
the single statewide toll-free telephone number
(1-800-96ABUSE).
L. Transportation Disadvantaged
If clients are to be transported under this contract,
the provider will comply with the provisions of
Chapter 427, FS, and Rule Chapter 41-2, FAC. The
provider shall submit to the department the reports
required pursuant to Volume 10, Chapter 27, HRS
Accounting Procedures Manual.
M.Purchasing
1. PRIDE
It is agreed that any articles which are the subject
of, or are required to carry out this contract shall
be purchased from Prison Rehabilitative Industries
and Diversified Enterprises, Inc. (pRIDE)
identified under Chapter 946, FS, in the same
manner and under the procedures set forth in
subsections 946.515(2) and (4). For purposes of
this contract, the provider shall be deemed to be
substituted for the department insofar as dealings
with PRIDE. This clause is not applicable to
subcontractors, unless otherwise required by law.
An abbreviated list of products/services available
from PRIDE may be obtained by contacting
PRIDE, (904) 487-3774.
2. Procurement of Materials with Recycled
Content
Additionally, it is expressly understood and agreed
that any products or materials which are the
subject of, or are required to carry out this
contract shall be procured in accordance with the
provisions of s. 403.7065, and 287.045, FS.
3
7/1/95
N.Civil Rights Requirements
1. To comply with all federal, state, and local laws
and ordinances applicable to the work or payment
for work thereof, including the Americans With
Disabilities Act, and shall not discriminate on the
grounds of race, color, religion, sex, age,
handicap, national origin, political affiliation, or
beliefs, in the performance of this contract.
The provider agrees that compliance with this
assurance constitutes a condition of continued
receipt of or benefit from funds provided through
this contract, and that it is binding upon the
provider, its succors, transferees, and assignees
for the period during which services are provided.
The provider further assures that all contractors,
subcontractors, sub grantees, or others with whom
it arranges to provide services or benefits to
participants or employees in connection with any
of its programs and activities are not
discriminating against those participants or
employees in violation of the above statutes,
regulations, guidelines, and standards.
2.Compliance Questionnaire
In accordance with HRSM 220-2, the provider
agrees to complete the Civil Rights Compliance
Questionnaire, HRS Forms 946 A and B, if
services are provided to clients and if 15 or more
individuals are employed.
O.Withholdings and Other Benefits
The provider is responsible for Social Security and
Income Tax withholdings. The provider is not
entitled to state retirement or leave benefits except
where the provider is a state agency. Unless
justified by the provider and agreed to by the
department in Attachment I, the department will not
furnish services of support (e.g., office space, office
supplies, telephone service, secretarial, or clerical
support) normally available to career service
employees.
P .Sponsorshi p
As required by s. 286.25, FS, if the provider is a
nongovernmental organization which sponsors a
program financed wholly or in part by state funds,
including any funds obtained through this contract, it
shall, in publicizing, advertising or describing the
sponsorship of the program, state: "Sponsored by
(provider's name) and the State of Florida
,
Department of Health and Rehabilitative Services".
Contract No. ~oif--
If the sponsorship reference is in written material
the words "State of Florida, Department of Health
and Rehabilitative Services" shall appear in the same
size letters or type as the name of the organization.
Q.Final Invoice
To submit the final invoice for payment to the
department no more than 45 days after the Contract
ends or is terminated. If the provider fails to do so
all right to payment is forfeited and the departmen~
will not honor any requests submitted after the
aforesaid time period. Any payment due under the
terms of this contract may be withheld until all
reports due from the provider and necessary
adjustments thereto have been approved by the
department.
R.Use Of Funds For Lobbying Prohibited
To comply with the provisions of section 216.347,
FS, which prohibits the expenditure of contract
funds for the purpose of lobbying the Legislature,
judicial branch or a state agency.
II. THE DEPARTMENT AGREES:
I
'~, A.Contract Amount
To pay for contracted services according to the
conditions of Attachment I in an amount not to
exceed $N/ A, subject to the availability of funds.
The State of Florida's performance and obligation to
pay under this contract is contingent upon an annual
appropriation by the Legislature. The costs of
services paid under any other contract or from any
other source are not eligible for reimbursement
'f-under this contract.
B.Contract Payment
Pursuant to s.215.422, FS, provides that the
department has five (5) working days to inspect and
approve goods and services, unless bid specifications
or the P.O. specifies otherwise. With the exception
of payments to health care providers for hospital,
medical, or other health care services, if payment is
not available within 40 days, measured from the
latter of the date the invoice is received or the goods
or services are received, inspected and approved, a
separate interest penalty set by the Comptroller
pursuant to s. 55.03, FS, will be due and payable in
addition to the invoice amount. To obtain the
applicable interest rate, please contact the district
fiscal office/contract administrator. Payments to
health care providers for hospitals, medical or other
health care services, shall be made not more than 35
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days from the date of eligibility for payment is
determined, and the monthly interest rate is 1%.
Invoices returned to a vendor due to preparation
errors will result in a payment delay. Invoice
payment requirements do not start until a properly
completed invoice is provided to the department.
C.Vendor Ombudsman
A Vendor Ombudsman has been established within
the Department of Banking and Finance. The duties
of this individual include acting as an advocate for
vendors who may be experiencing problems in
obtaining timely payment(s) from a state agency.
The Vendor Ombudsman may be contacted at (904)
488-2924 or 1-800-848-3792, the State
Comptroller's Hotline.
m. THE PROVIDER AND DEPARTMENT
MUTUALLY AGREE:
A.Effective and Ending Dates
This contract shall begin on July 1. 1995 or on the
date on which the contract has been signed by both
parties, whichever is later, and end on June 30.
.l.22Q.
B. Termination
. 1. Termination at Will
This contract may be terminated by either party
upon no less than thirty (30) calendar days notice,
without cause, unless a lesser time is mutually
agreed upon by both parties. Said notice shall be
delivered by certified mail, return receipt
requested, or in person with proof of delivery.
2. Termination Because of Lack of Funds
In the event funds to finance this contract become
unavailable, the department may terminate the
contract upon no less than twenty-four (24) hours
notice in writing to the provider. Said notice shall
be delivered by certified mail, return receipt
requested, or in person with proof of delivery.
The department shall be the final authority as to
the availability of funds.
3. Termination for Breach
This contract may be terminated for non-
performance by the provider upon no less than
twenty-four (24) hours notice. If applicable the
department may employ the default provisions in
Chapter 6OA-1.006 (3), FAC. Waiver of breach
of any provisions of this contract shall not be
Contract No. (410'{
deemed to be a waiver of any other breach and
shall not be construed to be a modification of the
terms of this contract. The provisions herein do
not limit the department's right to remedies at law
or to damages.
C.Name, Mailing and Street Address of Payee
1. The name (provider name as shown on page 1 of
this contract) and mailing address of the official
payee to whom the payment shall be made is:
The City of Miami Beach
8128 Collins Avenue
Miami Beach. Florida 33141
2. The name of the contact person and street address
where financial and administrative records are
maintained:
AlZi Long
8128 Collins Avenue
Miami Beach. Florida 33141
(305) 993-2008
D.Renegotiation or Modification
Modifications of provisions of this contract shall
only be valid when they have been reduced to
writing and duly signed. The rate of payment and
the total dollar amount may be adjusted retroactively
to reflect price level increases and changes in the
rate of payment when these have been established
through the appropriations process and subsequently
identified in the department's operating budget.
E.Notice and Contact
I.The name, address and telephone number of the
contract manager for the department for this contract
is:
Don Hill
401 North West Second Avenue - Suite S522
Miami. Florida 33128
(305) 377-5969
2. The name, address and telephone number of the
representative of the provider responsible for
administration of the program under this contract:
AlZi LonlZ
8128 Collins Avenue
Miami Beach. Florida 33141
(305) 993-2008
3.In the event that different representatives are
designated by ei,tper party after execution of this
contract, . notice of the name and address of the new
representative will be rendered in writing to the other
5
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party and said notification attached to originals of
this contract.
Contract No. f:!.Lloy.
F.All Terms and Conditions Included
This contract and its attachments as referenced
,
Attachments I. II. and Exhibits A. B. C. D. E. and F
contain all the terms and conditions agreed upon by the
parties.
IN WITNESS THEREOF, the parties hereto have caused this 47 page contract to be executed by their undersigned
officials as duly authorized.
TITLE: Mavor
DATE:
STATE AGENCY 29 DIGIT SAMAS CODE:
N/A
Federal EID # (or SSN) VF596000372001
Provider Fiscal Year Ending Date: .June 30
..
STATE OF FLORIDA, DEPARTMENT OF
HEALTH AND REHABILITATIVE SERVICES
SIGNED BY:
~;/
~;;/1'S
NAME: Anita M. Bock
TITLE: District Administrator
DATE:
6
Contract No.
I<L/o'f
CERTIFICATION REGARDING
DEBARMENT. SUSPENSION. INELIGIBILITY AND VOLUNTARY EXCLUSION
CONTRACTS/SUBCONTRACTS
This certification is required by the regulations implementing Executive
Order 12549, Debarment and Suspension, signed February 18, 1986. The
guidelines were published in the May 29, 1987 Federal Register (52 Fed.
Reg., pages 20360-20369).
INSTRUCTIONS
1. Each provider whose contract/subcontract equals or exceeds $25,000 in federal monies
must sign this certification prior to execution of each contract/subcontract. Additionally
providers who audit federal programs must also sign, regardless of the contract amount.
HRS cannot contract with these tvpes of providers if thev are debarred or suspended bv the
federal Government.
2. This certification is a material representation of fact upon which reliance is placed
when this contract/subcontract is entered into. If it is later determined that the signer
knowlngly rendered an erroneous certification, the Federal Government may pursue available
remedies, including suspension and/or debarment.
3. The provider shall provide immediate written notice to the contract manager at any
time the provider learns that its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.
4. The terms "debarred," "suspended," "ineligible," "person," "principal," and
"voluntarily excluded," as used in this certification, have the meanings set out in the
Definitions and Coverage sections of rules implementing Executive Order 12549. You may
contact the contract manager for assistance in obtaining a copy of those regulations.
5. The provider agrees by submitting this certification that, it shall not knowingly
enter into any subcontract with a person who i~ debarred, suspended, declared ineligible,
or voluntarily excluded from participation in this contract/subcontract unless authorized
by the Federal Government.
6. The provider further agrees by submitting this certification that it will require each
subcontractor of this contract/subcontract, whose payment will equal or exceed $25/000 in
federal monies, to submit a signed copy of this certification.
7. The Department of Health and Rehabilitative Services may rely upon a certification of
a provider that it is not debarred, suspended, ineligible, or voluntarily excluded from
contracting/subcontracting unless it knows that the certification is erroneous.
8. This signed certification must be kept in the contract manager's contract file.
Subcontractor's certifications must be kept at the contractor's business location
CERTIFICATION
(1) The prospective provider certifies, by signing this certification, that neither he
nor his principals is presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from participation in this contract/subcontract by any
federal department or agency.
(2) Where th
certification,
certificatio
unable to certify to any of the statements in this
der shall attach an explanation to this
Date'
Gelber, Ma or
Name and Title of uthorized Signee
[~ DISTRICT II DADE and MONROE COllNTlES
D"I',\InM":'\T OF III:^,.TII & REI IAIIII.ITATI VE SEJ.tVIC1:.<;
"COMMITTED TO EXCELLENCE"
DOCUMENTATION OF NEG.O!~ATION AGREEMENT
THIS AGREEMENT, is entered into between the State of Florida, Department Of Health and
Rehabilitative Services, Developmental Services Program Office known as the Department and
City Of Miami Beach known as the Provider.
The following parties agree to the following items and terms set forth during the negotiation
meeting on May 1, 1995.
AGREEMENT: .
The rate per unit of service as listed on this document, applies to the services specified
below whether funded through this Rate Agreement or Medicaid WaNer.. . '
FY 95 96 9596 FY 95 96 FY 95-96
CONTRACllJAL TOTAL
NEGOTIATED CONSUMERS CALCULATIONS GIR
RATES TO BE SERVED FUNDING
Adult De $ 24.50 Dall 8 24.50 X 8 X 230 $45,080.00
S E I ment $ 426.00 Month 15 426.00 X 15 X 12 $76.680.00
$ 485.00 Month 485.00 x 1 x 12 $5,820.00
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Title: Progr5I1 Administra or
KL I 0 t.f
FUNDING $136 726.88
H.R.S. Raspes.ntati~ A
Budgets/Contracts: ~
Contract ~ I ~ --//;/
Provider Representatives:
Date:
DISTRICT ELEVEN
LAWTON CHILES. GOVERNOR
RESOLUTION NUMBER 96-21980
A RESOLUTION OF THE MA VOR AND CITY COMMISSION OF
THE CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING AND
DIRECTING THE MAYOR AND CITY CLERK TO EXECUTE
"AMENDMENT NO.2" TO CONTRACT NUMBER KL104 WITH
THE DEPARTMENT OF HEALTH AND REHABILITATIVE
SERVICES (HRS) IN ORDER TO COMPLY WITH HRS' NEW
BILLING PROCESS.
WHEREAS, on June 7, 1995, the City signed and executed Contract Number
KL 104 with the State of Florida Department of Health and Rehabilitative Services (HRS),
for funding of the Adult Developmental Training Program at the City's Log Cabin Training
Center (Contract); and
WHEREAS, said Contract is in full force and effect; and
WHEREAS, in order to comply with the HRS requirements, the City must amend the
Contract to include the revised attachment, entitled "Amendment No.2", reflecting that
funds in the Contract will be transferred from HRS general revenue contractual slots to
HRS Medicaid Waiver slots; and
WHEREAS, HRS has assured the City that this action will in no way effect the City's
ability to collect the total funds contemplated in the Contract; and
WHEREAS, no other changes to the Contract are being made at this time.
NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City
Commission hereby authorize the Mayor and City Clerk to execute the attached
Amendment No. 2 to Contract Number KL 104 with the Department of Health and
Rehabilitation Services (HRS).
PASSED AND ADOPTED THIS
,1996.
ATTEST:
~o~~ ~aA-~
CITY CLERK
M APPROVED
L1JL DEPT.
By ~
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